Study identifies ways to improve antiviral prescribing for infants with flu
Click Here to Manage Email Alerts
Key takeaways:
- Infants were less likely to receive oseltamivir if they did not have a fever or had symptoms for more than 48 hours.
- Providers were less likely to prescribe oseltamivir while waiting for delayed test results.
Presence of a fever and time since symptom onset were two factors that affected whether providers prescribed oseltamivir to infants with influenza, according to findings published in Journal of the Pediatric Infectious Diseases Society.
The CDC recommends oseltamivir for infants aged younger than 2 years with confirmed or suspected influenza. Overall, adherence to guidelines is high, but there is still room for improvement, according to researchers.
“When given early in the course of illness, oseltamivir reduces the length of stay in hospitalized children, their risk for readmission and escalation of care, such as need for the ICU,” Anne-Marie Rick, MD, PhD, MPH, assistant professor of pediatrics and clinical and translational Science and codirector of newborn research support services at the University of Pittsburgh School of Medicine, told Healio.
“Treatment has important implications beyond the child’s health outcomes as well, because a child who has less symptoms or less fever, even if just by 12 to 24 hours, means kids getting back to day care faster and parents getting back to work,” Rick said.
Rick and colleagues conducted a retrospective cohort study that included 457 infants (54% boys) aged younger than 2 years who tested positive for influenza between Jan. 1, 2012, through July 31, 2020. The researchers analyzed how many of these infants received oseltamivir prescriptions and compared prescription rates based on time since symptom onset, presence of fever and type of influenza test.
Most of the cases (82.1%) occurred from Aug. 1, 2016, through July 31, 2020, which Rick and colleagues attributed to “the acquisition of additional pediatric practices into our health system and increased alignment of EHRs during this time, as well as increased availability and utilization of [rapid influenza diagnostic tests (RIDT)] within outpatient and urgent care settings across our health system beginning in 2018.”
Two-thirds (68.5%) of the infants were aged 6 months or older and thus eligible for influenza vaccination, but less than one-third (31%) of eligible infants had received two doses of influenza vaccine at the time of influenza diagnosis.
Overall, 85.7% of infants received an oseltamivir prescription, with coverage improving throughout the study period, according to the researchers.
In the multivariable analysis, the researchers found that infants were less likely to receive an oseltamivir prescription if they did not have a fever at the time of diagnosis (OR = 2.3; 95% CI, 1.2-4.6) or if they had symptoms for more than 2 days (OR = 9.4; 95% CI, 4.8-18.7).
On the issue of timing, Rick and colleagues noted that the CDC and Infectious Diseases Society of America both recommend oseltamivir be given within 48 hours of the start of influenza symptoms, but that “this distinction is removed for high-risk populations including children [younger than] 2 years of age with a positive or suspected influenza diagnosis; instead oseltamivir is recommended as soon as possible.”
Infants were four times less likely to be prescribed antivirals if they were diagnosed with influenza between Jan. 1, 2012, and July 31, 2016, compared with infants diagnosed between Aug. 1, 2016, and July 31, 2020 (OR = 4.2; 95% CI, 1.8-9.5).
Infants who received a reverse transcriptase PCR test (OR = 2.7; 95% CI, 1.1-7.1) or a multiplex PCR test or viral culture (OR = 6.7; 95% CI, 2.7-16.3) were more likely not to receive an oseltamivir prescription compared with those who received an RIDT.
The increase in oseltamivir prescriptions over time — and greater likelihood of an infant receiving treatment after testing positive via an RIDT — “suggests a gradual adherence to the CDC’s antiviral guidelines after they were updated in 2011 to recommend antiviral treatment be given to children [younger than] 2 years of age as soon as possible,” Rich and colleagues wrote.
“If there will be a delay in receiving test results, clinicians should err on the side of presumptive treatment to improve adherence to Infectious Diseases Society of America guidelines and ultimately improve outcomes of young children with influenza,” Rick said.
“It is important for pediatric clinicians to recognize that all children less than 2 years of age, regardless of any underlying medical conditions, are considered high risk for the complications of influenza, and so prescription of oseltamivir is appropriate when influenza infection is confirmed or suspected regardless of when symptoms started.”
Collapse
Read more about
Click Here to Manage Email Alerts